Tissue fastening system and method

ABSTRACT

A fastening system includes first and second fastening members and a penetrating member. The first fastening member includes a backspan and a set of lobes that extend from the backspan. The second fastening member includes a backspan and a set of lobes that extend from the backspan. The penetrating member includes a first body which is substantially planar, a set of teeth, and a first trailing wall that extends from the first body orthogonal to a plane that is defined by the first body. The set of teeth extend from a leading edge of the first body which is opposite a trailing edge of the first body and are configured to pierce and spread tissue over the set of lobes of the first fastening member. The first trailing wall is configured to support the backspan of the first fastening member.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of and priority to U.S. ProvisionalPatent Application Ser. No. 62/159,407 filed May 11, 2015, the entiredisclosure of which is incorporated by reference herein.

BACKGROUND

1. Technical Field

The present disclosure relates to surgical fasteners and, morespecifically, to tissue fastening systems having polymeric staples andmethods for joining tissue with polymeric staples.

2. Discussion of Related Art

Surgical staples and stapling instruments are well known in the surgicalarts and have become an important part of many surgical procedures. Theuse of stapling instruments for applying staples to join tissue ortissue segments in a fast and efficient manner has obviated the timeconsuming step of manual suturing of tissue or tissue segments in avariety of surgical procedures, e.g., anastomoses procedures. Thereduced time required to perform these surgical procedures usingsurgical stapling instruments has resulted in reduced trauma and risk topatients.

Usually, surgical staples are made of a metal that is bio-compatible,but not bio-absorbable. The metal staples, therefore, must eventually beremoved by another device such as a staple extractor, which is not onlytime consuming but can cause discomfort and pain to the patient.

Plastic staples can be made bio-absorbable and do not affect medicalimaging techniques, such as magnetic resonance imaging, computertomography scanning, and ultrasound detection. Typically plastic staplesare resilient and do not possess the rigidity necessary to penetratetissue to be joined.

Accordingly, there is a need for stapling systems and methods forjoining tissue with plastic staples that penetrate tissue with theplastic staples.

SUMMARY

In an aspect of the present disclosure, a fastening system includes afirst fastening member, a second fastening member, and a penetratingmember. The first fastening member includes a backspan and a set oflobes that extend from the backspan which are configured toatruamatically pass through tissue. The second fastening member includesa backspan and a set of lobes that extend from the backspan. Thepenetrating member includes a first body, a set of teeth, and a firsttrailing wall. The first body is substantially planar. The firsttrailing wall extends from the first body orthogonal to a plane that isdefined by the first body along or adjacent a trailing edge of the firstbody. The set of teeth extend from a leading edge of the first bodywhich is opposite the trailing edge of the first body and in the planedefined by the first body. The set of teeth are configured to pierce andspread tissue over the set of lobes of the first fastening member. Thefirst trailing wall is configured to support the backspan of the firstfastening member.

In aspects, the fastening system includes a backing member that has asecond body and a second trailing wall. The second body is substantiallyplanar with the second trailing wall extending from the second bodyorthogonal to a plane defined by the second body along or adjacent atrailing edge of the second body. The second trailing wall is configuredto support the backspan of the second fastening ember. The first andsecond fastening members may be flexible and the penetrating member andthe backing member may be substantially rigid.

In some aspects, the set of lobes of the first fastening member definerecesses between each pair of lobes. The set of lobes of the secondfastening member may define recesses between each pair of lobes. Each ofthe recesses of the first fastening member may be configured to receivea respective lobe of the second fastening ember and each of the recessesof the second fastening member may be configured to receive a respectivelobe of the first fastening member.

In particular aspects, the set of lobes of the first fastening memberdefine a first tissue contacting surface and the set of lobes of thesecond fastening member define a seconding tissue contacting surface.The first and second fastening member may be configured to be securedalong the first and second tissue contacting surfaces. The first andsecond fastening members may be configured to be ultrasonically weldedtogether along the first and second tissue contacting surfaces. Thefirst and second fastening members may be bioabsorbable.

In another aspect of the present disclosure, a method of joining tissueincludes driving a penetrating member through tissue to be joined,contacting a first tissue contacting surface of a first fastening memberwith a second tissue contacting surface of a second fastening member,and securing the first and second contacting surfaces along a seam. Thefirst fastening member includes a set of lobes along the first tissuecontacting surface. The second tissue contacting surface is shaped tointerdigitate with the first tissue contacting surface. Securing thefirst and second tissue contacting surfaces along the seam which isdefined between the first and second tissue contacting surface withtissue to be joined disposed between portion of the first and secondtissue contacting surfaces. The first and second fastening members areflexible along the seam when the first and second fastening members aresecured together.

In aspects, securing the first tissue contacting surface to the secondtissue contacting surface along the seam includes ultrasonically weldingthe first tissue contacting surface to the second tissue contactingsurface along the seam. Ultrasonically welding the first tissuecontacting surface to the second tissue contacting surface along theseam includes delivering ultrasonic energy to the penetrating membersuch that the penetrating member ultrasonically welds the first tissuecontacting surface to the second tissue contacting surface along theseam.

In some aspects, driving the penetrating member through the tissue to bejoined includes driving a set of teeth that extend from the body throughthe tissue to be joined. The set of teeth may pierce the tissue to bejoined and guide the tissue to be joined over the lobes of the firstfastening member. Driving the penetrating member through the tissue tobe joined may include each tooth of the set of teeth being aligned witha respective lobe of the set of lobes such that the tooth pierces andthen guides the tissue to be joined over the respective lobe.

In particular aspects, driving the penetrating member through the tissueto be joined includes supporting a backspan of the first fasteningmember with a trailing wall that extends orthogonal to a plane definedby a body of the penetrating member. The trailing wall may engage thebackspan of the first fastening member to drive the set of lobes throughthe tissue to be joined. The method may include positioning the firstfastening member on the body of the penetrating member with the backspanof the first fastening member engaged with the trailing wall of thepenetrating member before driving the penetrating member through thetissue to be joined.

In certain aspects, contacting the first and second tissue contactingsurfaces includes supporting a backspan of the second fastening memberwith a backing member. Supporting the backspan of the second fasteningmember may include engaging the backspan of the second fastening memberwith a trailing wall extending orthogonal to a plane defined by a bodyof the backing member. The method may include positioning the secondfasting member on the body of the backing member with the backspan ofthe second fastening member engaged with the trailing wall of thebacking member before contacting the first tissue contacting surfacewith the second tissue contacting surface.

Further, to the extent consistent, any of the aspects described hereinmay be used in conjunction with any or all of the other aspectsdescribed herein.

BRIEF DESCRIPTION OF THE DRAWINGS

Various aspects of the present disclosure are described hereinbelow withreference to the drawings, which are incorporated in and constitute apart of this specification, wherein:

FIG. 1 is a top view of a tissue fastening system provided in accordancewith the present disclosure;

FIG. 2 is a perspective view of the first fastening member of FIG. 1received in the penetrating member of FIG. 1;

FIG. 3 is a perspective view of the penetrating member of FIG. 1;

FIG. 4 is a top view of the tissue fastening system of FIG. 1 withtissue positioned between the first and second fastening members;

FIG. 5 is a top view of the tissue fastening system of FIG. 4 with thepenetrating member driven through tissue and the first and secondfastening members in contact with one another;

FIG. 6 is a top view of the tissue fastening system of FIG. 5 with thepenetrating member and backing member withdrawn from the first andsecond fastening members respectively;

FIG. 7 is a side view of a surgical instrument provided in accordancewith the present disclosure including a penetrating member and a backingmember;

FIG. 8 is a side view of another penetrating member provided inaccordance with the present disclosure;

FIG. 9 is a side view of another backing member provided in accordancewith the present disclosure; and

FIG. 10 is a side view of another penetrating member provided inaccordance with the present disclosure.

DETAILED DESCRIPTION

Embodiments of the present disclosure are now described in detail withreference to the drawings in which like reference numerals designateidentical or corresponding elements in each of the several views. Asused herein, the term “clinician” refers to a doctor, a nurse, or anyother care provider and may include support personnel. Throughout thisdescription, the term “proximal” refers to the portion of the device orcomponent thereof that is closest to the clinician and the term “distal”refers to the portion of the device or component thereof that isfarthest from the clinician.

This disclosure relates generally to a tissue fastening system includinga metal penetrating member and a flexible plastic fastener memberreceived by the metal penetrating member. In use, the metal penetratingmember pierces tissue and pushes the plastic fastener member through thepenetrated tissue. The plastic fastener member is then secured to aplastic retainer to join the penetrated tissue together. The plasticstaple may be secured to the plastic retainer by ultrasonic welding.When the penetrated tissue is joined with the plastic fastener memberand the plastic retainer, the plastic fastener member and the plasticretainer are flexible enough to allow the penetrated tissue to flexwithout separating. The plastic fastener member and the plastic retainermay be bioabsorbable such that as the penetrated tissue heals, theplastic fastener member and the plastic retainer are absorbed by thebody.

Referring now to FIG. 1, a fastening system 10 for joining tissue withbioabsorbable fastening members 30, 40 is provided in accordance withthe present disclosure. The fastening system 10 includes a penetratingmember 20, the first fastening member 30, the second fastening member40, and a backing member 50. The penetrating member 20 and the backingmember 50 are substantially rigid and constructed from biocompatiblemetal or alloy thereof (e.g., surgical steel, titanium, etc.). The firstand second fastening members 30, 40 are flexible and constructed from abioabsorbable material that will be absorbed by the body of a patientafter a predetermined amount of time within the body of a patient.Examples of such bioabsorbable materials include, but are not limitedto, urethanes blended with lactic acid and/or glycolic acid,homopolymers thereof or copolymers thereof, and acrylates blended withcaprolactones such as polycaprolactone dimethacrylate poly(butylacrylate) blends, and combinations thereof which are disclosed in U.S.Pat. No. 8,323,316, the entire contents of which are hereby incorporatedby reference.

With additional reference to FIGS. 2 and 3, the penetrating member 20has a body portion 22 and an arcuate trailing wall 24. The body portion22 is substantially planar and defines a shelf 26 on the upper surfacethereof. The shelf 26 is configured to receive the first fasteningmember 30 such that the trailing wall 24 supports a backspan 32 of thefirst fastening member 30, as detailed below. The leading edge of thebody portion 22 includes teeth 27 extending away from the trailing wall24. The teeth 27 are shaped to penetrate tissue and have sides 28 thatintersect at a tip 29. As detailed below, the tip 29 is configured tofacilitate penetration of tissue and the sides 28 of the teeth 27 areconfigured to cut and separate tissue as the first fastening member 30is driven through tissue.

With particular reference to FIG. 1, each tooth 27 is substantiallytriangular in shape with substantially linear sides 28. It iscontemplated that the sides 28 of each tooth 27 may be arcuate. Forexample, each of the sides 28 may be concave in profile to decrease thethickness of the tooth 27 or convex in profile to increase the thicknessof the tooth 27 when compared to a tooth 27 with substantially linearsides 28. In addition, the sides 28 of each tooth 27 may be concave inprofile adjacent the tip 29 and convex in profile adjacent the bodyportion 22 such that the tooth 27 penetrates and then spreads penetratedtissue. Alternatively, the penetrating member can be configured with aplurality, or one or more, elongate prongs.

With continued reference to FIGS. 1-3, the first and second fasteningmembers 30, 40 each include a backspan 32, 42 and lobes 36, 46. Thelobes 36, 46 extend from a respective backspan 32, 42. The lobes 36, 46form a tissue contacting surface 35, 45 and define a plurality ofrecesses 38, 48 therebetween. The lobes 36 of the first fastening member30 are aligned with the recesses 48 of the second fastening member 40such that the lobes 36 are receivable in the recesses 48 (i.e., thelobes 36 and the recesses 48 interdigitate). Similarly, the lobes 46 ofthe second fastening member 40 are aligned with the recesses 38 of thefirst fastening member 30 such that the lobes 46 are receivable in therecesses 38. When the lobes 36, 46 are received in the recesses 38, 48,respectively, the tissue contacting surfaces 35, 45 of the first andsecond fastening members 30, 40 abut one another to form a seam S (FIG.5) between the first and second fastening members 30, 40.

The backing member 50 is configured to support the second fasteningmember 40 and includes a body 52 and a trailing wall 54. The body 52defines a shelf 56 sized to receive the backspan 42 of the secondfastening member 40 as detailed below.

With particular reference to FIG. 2, the first fastening member 30 issized to be received by the shelf 26 of the penetrating member 20. Whenthe first fastening member 30 is received by the shelf 26 of thepenetrating member 20, each lobe 36 of the first fastening member 30 ispositioned adjacent one of the teeth 27 of the penetrating member 20.The lobes 36 may be in contact with a respective one of the teeth 27. Inaddition, when the first fastening member 30 is received by the shelf 26of the penetrating member 20, each tooth 27 of the penetrating member 20is aligned with one of the lobes 36 of the first fastening member 30such that the tip 29 of the tooth 27 extends past the lobe 36. As shown,each tooth 27 substantially bisects each lobe 36; however, it iscontemplated that each tooth 27 may be offset from a centerline of eachlobe 36. As detailed below, when the penetrating member 20 is driventhrough tissue, the tips 29 of each tooth 27 pierce tissue and the sides28 of the teeth 27 separate the tissue such that each lobe 36 passesthrough an opening made by a respective tooth 27.

Referring to FIGS. 4-6, a method for joining tissue is described inaccordance with the present disclosure. Initially, the first fasteningmember 30 is positioned on the body portion 22 of the penetrating member20 such that the first fastening member 30 is received by the shelf 26and the second fastening member 40 is positioned on the body portion 52of the backing member 50 such that the second fastening member 40 isreceived by the shelf 46 as shown in FIG. 4. Next, the penetratingmember 20 is driven through tissue T such that the tips 29 of the teeth27 of the penetrating member 20 create openings or incisions in thetissue T. As the teeth 27 are driven through the tissue T, the sides 28of the teeth 27 enlarge the incisions I by spreading the tissue T overthe teeth 27. As the incisions are enlarged, the lobes 36 of the firstfastening member 30 pass through the enlarged incisions of the tissue T.The second fastening member 40 is positioned on an opposite side of thetissue T from the backspan 32 of the first fastening member 30 andaligned with the first fastening member 30 such that the lobes 36 of thefirst fastening member 30 are received in recesses 48 of the secondfastening member 40 as detailed above. The backing member 50 ispositioned against the backspan 42 of the second fastening member 40 tosupport the backspan 42 as the first fastening member 30 is driventhrough the tissue T and into contact with the second fastening member40.

With particular reference to FIG. 5, when the tissue contacting surface35 of the first fastening member 30 contacts the tissue contactingsurface 45 of the second fastening member 40, each tooth 27 of thepenetrating member 20 may extend past the tissue contacting surface 45of the second fastening member 40 adjacent a respective one the recesses48 of the second fastening member 40. When the tissue contactingsurfaces 35, 45 of the first and second fastening members 30, 40 are incontact with one another, the first and second fastening members 30, 40are joined together along a seam S formed by the tissue contactingsurfaces 35, 45. The first and second fastening members 30, 40 may bejoined together by welding (e.g., ultrasonically welding) the first andsecond fastening members 30, 40 together along the seam S. Additionallyor alternatively, the first and second fastening members 30, 40 may bejoined together by adhesive applied to the tissue contacting surfaces35, 45. As the first and second fastening members 30, 40 are joinedtogether, the penetrating member 20 and the backing member 50 may beurged towards one another to apply pressure to the tissue contactingsurfaces 35, 45 along the seam S.

The ultrasonic energy may be applied to the first and second fasteningmembers 30, 40 by the penetrating member 20. The body portion 22 of thepenetrating member 20 may be operatively coupled to a source ofultrasonic energy such that the teeth 27 of the penetrating member 20deliver ultrasonic energy to the seam to ultrasonically weld the firstand second fastening members 30, 40 together along the seam S.

When the first and second fastening members 30, 40 are joined together,the penetrating member 20 is withdrawn from the tissue T and the backingmember 50 is removed from the backspan 42 of the second fastening member40 such that the first and second fastening members 30, 40 remain thejoined together with tissue therebetween as shown in FIG. 6. As detailedabove, the first and second fastening members 30, 40 are constructed ofa bioabsorbable material such that after anastomosis of the joinedtissue is completed, the body of the patient absorbs the first fasteningmember 30 and the second fastening member 40. In addition, the first andsecond fastening members 30, 40 may be flexible to allow the tissue toflex along the seam while securing the tissue together.

With reference to FIG. 7, a surgical instrument 70 is provided inaccordance with this disclosure and includes a first member 72 and asecond member 76 that are pivotally secured to one another. The firstand second members 72, 76 each include a handle 73, 77 at a proximal endand a jaw member 74, 78 at the distal end. The first and second member72, 76 are pivotable about a pivot 79 positioned between the handles 73,77 and the jaw members 74, 78. The penetrating member 20, as detailedabove, is positioned on the jaw member 74 of the first member 72 and thebacking member 50 is positioned on the jaw member 78 of the secondmember 76. When the handles 73, 77 are approximated towards one another,the penetrating member 20 and the backing member 50 are approximatedtowards one another.

As the handle 73 of the first member 72 is pivoted towards the handle 77of the second member 76, the jaw member 74 moves the penetrating member20 towards the backing member 50 supported on the jaw member 78 of thesecond member 76 which is moving towards the penetrating member 20. Asshown, the penetrating member 20 and the backing member 50 are pivotedtowards one another; however, it is also contemplated that the surgicalinstrument may be configured such that the penetrating member 20 and thebacking member 50 move towards one another in a parallel manner. Whenthe first and second members 72, 76 are approximated relative to oneanother, an ultrasonic instrument (not shown) may be used to deliverultrasonic energy to first and second fastening members (e.g., first andsecond fastening members 30, 40) disposed in the penetrating member 20and the backing member 50, respectively.

Alternatively, the first member 72 may be associated with an ultrasonicenergy source 80 (e.g., a generator). As shown, the ultrasonic energysource 80 is disposed within the first member 72; however, theultrasonic energy source 80 may be remote to the surgical instrument 70and coupled to the first member 72 by a cable 82. The handle 77 of thesecond member 76 includes an activation switch 84 for selectivelydelivering ultrasonic energy to the teeth 27 of the penetrating member20 positioned on the jaw member 74 of the first member 72. When thefirst and second members 72, 76 are approximated with respect to oneanother, the activation switch 84 is depressed such that the ultrasonicenergy source 80 is activated such that the teeth 27 of the penetratingmember 20 weld first and second fastening members 30, 40 received by ashelf 26, 56 of the penetrating member 20 and the backing member 50,respectively, together along a seam S defined between the first andsecond fastening members 30, 40, as detailed above.

Referring to FIGS. 8-9, another penetrating member 120 and backingmember 150 are provided in accordance with the present disclosure. Thepenetrating member 120 and the backing member 150 are substantiallysimilar to the penetrating member 20 and the backing member 50 detailedabove, as such only the differences will be detailed herein for reasonsof brevity.

The penetrating member 120 includes a body 122, a trailing wall 124, andan upper plate 134. The trailing wall 124 supports the upper plate 134substantially parallel to the body 122 such that a shelf or cavity 126is defined between the upper plate 134 and the body 122. The cavity 126is configured to receive and support the backspan 34 of the firstfastening member 30 in a manner substantially similar to the shelf 26detailed above with respect to the penetrating member 20. In addition,the trailing wall 124 may support the upper plate 134 slightly askewfrom the body 122 of the penetrating member 120 with a leading end 136of the upper plate 134 closer to the body 122 than a trailing end 138 ofthe upper plate 134. In such embodiments, the leading end 136 may engagethe first fastening member 30 to partially secure the first fasteningmember 30 within the cavity 126.

The backing member 150 includes a body 152, a trailing wall 154, and anupper plate 164. The trailing wall 156 supports the upper plate 164substantially parallel to the body 152 such that a shelf or cavity 156is defined between the upper plate 164 and the body 152. The cavity 156is configured to receive and support the backspan 44 of the secondfastening member 40 in a manner substantially similar to the shelf 56detailed above with respect to the backing member 50. In addition, thetrailing wall 154 may support the upper plate 164 slightly askew fromthe body 152 of the backing member 150 with a leading end 166 of theupper plate 164 closer to the body 152 than a trailing end 168 of theupper plate 164. In such embodiments, the leading end 166 may engage thesecond fastening member 40 to partially secure the second fasteningmember 40 within the cavity 166.

Referring now to FIG. 10, another penetrating member 220 is provided inaccordance with the present disclosure. The penetrating member 220 issubstantially similar to the penetrating member 120 detailed above, assuch only the differences will be detailed herein for reasons ofbrevity.

The penetrating member 220 includes a body 222, a trailing wall 224, andan upper plate 234. The trailing wall 224 supports the upper plate 234substantially parallel to the body 222 such that a shelf or cavity 226is defined between the upper plate 234 and the body 222. The upper plate234 has a leading end 236 having teeth 237 that are substantiallyaligned in profile with teeth 227 extending from the body 222. The teeth227, 237 are substantially similar to the teeth 27 detailed above withrespect to penetrating member 20 such that when the first fasteningmember 30 is positioned within the cavity 226, the teeth 227, 237substantially bisect the lobes 36 of the first fastening member 30 topenetrate and separate tissue over the lobes 36. In addition, thetrailing wall 224 may support the upper plate 234 slightly askew fromthe body 222 of the penetrating member 220 with a leading end 236 of theupper plate 234 closer to the body 222 than a trailing end 238 of theupper plate 234. In such embodiments, the teeth 227 may engage the lobes38 of the first fastening member 30 to partially secure the firstfastening member 30 within the cavity 226.

In addition, the first and second fastening members 30, 40 may be joinedtogether by ultrasonic energy being applied to the first and secondfastening members 30, 40 by the teeth 227, 237. The body portion 222 ofthe penetrating member 220 may be operatively coupled to a source ofultrasonic energy such that the teeth 227, 237 of the penetrating member220 deliver ultrasonic energy to the seam to ultrasonically weld thefirst and second fastening members 30, 40 together along the seam S.

While several embodiments of the disclosure have been shown in thedrawings, it is not intended that the disclosure be limited thereto, asit is intended that the disclosure be as broad in scope as the art willallow and that the specification be read likewise. Any combination ofthe above embodiments is also envisioned and is within the scope of theappended claims. Therefore, the above description should not beconstrued as limiting, but merely as exemplifications of particularembodiments. Those skilled in the art will envision other modificationswithin the scope of the claims appended hereto.

What is claimed:
 1. A fastening system comprising: a first fasteningmember having a backspan and a set of lobes extending from the backspanconfigured to atraumatically pass through tissue; a second fasteningmember having a backspan and a set of lobes extending from the backspan;and a penetrating member including a first body, a set of teeth, and afirst trailing wall, the first body being substantially planar and thefirst trailing wall extending orthogonal to a plane defined by the firstbody along a trailing edge of the first body, the set of teeth extendingfrom a leading edge of the first body opposite the trailing edge of thefirst body and in the plane defined by the first body, the set of teethconfigured to pierce and spread tissue over the set of lobes of thefirst fastening member, the first trailing wall configured to supportthe backspan of the first fastening member.
 2. The fastening systemaccording to claim 1, further comprising a backing member including asecond body and a second trailing wall, the second body beingsubstantially planar and the second trailing wall extending orthogonalto a plane defined by the second body along a trailing edge of thesecond body, the second trailing wall configured to support the backspanof the second fastening member.
 3. The fastening system according toclaim 1, wherein the first and second fastening members are flexible andthe penetrating member is substantially rigid.
 4. The fastening systemaccording to claim 1, wherein the set of lobes of the first fasteningmember define recesses between each pair of lobes, and wherein the setof lobes of the second fastening member define recesses between eachpair of lobes, each of the recesses of the first fastening memberconfigured to receive a respective lobe of the second fastening memberand each of the recesses of the second fastening member configured toreceive a respective lobe of the first fastening member.
 5. Thefastening system according to claim 1, wherein the set of lobes of thefirst fastening member defines a first tissue contacting surface and theset of lobes of the second fastening member defines a second tissuecontacting surface, the first and second fastening members configured tobe secured together along the first and second tissue contactingsurfaces.
 6. The fastening system according to claim 5, wherein thefirst and second fastening members are configured to be ultrasonicallywelded together along the first and second tissue contacting surfaces.7. The fastening system according to claim 1, wherein the first andsecond fastening members are bioabsorbable.
 8. A method of joiningtissue comprising: driving a penetrating member through tissue to bejoined to drive a first fastening member through the tissue to bejoined, the first fastening member including a set of lobes along afirst tissue contacting surface; contacting the first tissue contactingsurface with a second tissue contacting surface of a second fasteningmember, the second tissue contacting surface shaped to interdigitatewith a shape of the first contacting tissue surface; and securing thefirst tissue contacting surface to the second tissue contacting surfacealong a seam defined between the first and second tissue contactingsurfaces with the tissue to be joined disposed between portions of thefirst and second tissue contacting surfaces, the first and secondfastening members being flexible along the seam when the first andsecond fastening members are secured together.
 9. The method accordingto claim 8, wherein securing the first tissue contacting surface to thesecond tissue contacting surface along the seam includes ultrasonicallywelding the first tissue contacting surface to the second tissuecontacting surface along the seam.
 10. The method according to claim 9,wherein ultrasonically welding the first tissue contacting surface tothe second tissue contacting surface along the seam includes deliveringultrasonic energy to the penetrating member such that the penetratingmember ultrasonically welds the first tissue contacting surface to thesecond tissue contacting surface along the seam.
 11. The methodaccording to claim 8, wherein driving the penetrating member through thetissue to be joined includes driving a set of teeth extending from thebody through the tissue to be joined, the set of teeth piercing thetissue to be joined and guiding the tissue to be joined over the lobesof the first fastening member.
 12. The method according to claim 11,wherein driving the penetrating member through the tissue to be joinedincludes each tooth of the set of teeth being aligned with a respectivelobe of the set of lobes such that the tooth pierces and guides thetissue to be joined over the respective lobe.
 13. The method accordingto claim 8, wherein driving the penetrating member through the tissue tobe joined includes supporting a backspan of the first fastening memberwith a trailing wall extending orthogonal to a plane defined by a bodyof the penetrating member, the trailing wall engaging the backspan ofthe first fastening member to drive the set of lobes though the tissueto be joined.
 14. The method according to claim 13, further comprisingpositioning the first fastening member on the body of the penetratingmember with the backspan of the first fastening member engaged with thetrailing wall of the penetrating member before driving the penetratingmember through the tissue to be joined.
 15. The method according toclaim 8, wherein contacting the first tissue contacting surface with thesecond tissue contacting surface includes supporting a backspan of thesecond fastening member with a backing member.
 16. The method accordingto claim 15, wherein supporting the backspan of the second fasteningmember includes engaging the backspan of the second fastening memberwith a trailing wall extending orthogonal to a plane defined by a bodyof the backing member.
 17. The method according to claim 16, furthercomprising positioning the second fastening member on the body of thebacking member with the backspan of the second fastening member engagedwith the trailing wall of the backing member before contacting the firsttissue contacting surface with the second tissue contacting surface.